Group Membership Form For groups whose main purpose is cultural or multicultural Name of Group*Group's Representative* First Last Position / Job Title*Phone*Address* Street Address Address Line 2 City/Suburb State/Territory Post code Email* Are you renewing your membership or are you a new member?*Please selectMembership renewalNew memberBriefly describe your group’s purpose or activities:*Member Statement* My group agrees to support multiculturalism and abide by the rules of the association Group membership Fee* Price: $ 5.00 Would you also like to make a donation?*Yes pleaseNo thanksDonation amount: Total $ 0.00 I would like to pay by:*Credit cardPayPalCredit Card MasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name